Stop HAIs in Their Tracks

This is an image of Acinetobacter Baumannii bacteria, which is an emerging cause of hospital aquired pulmonary, i.e., pneumoniae, hemopathic, and wound infections.

In the late 19th century, doctors considered the appearance of a white puss around wounds to be a sign that the healing process had begun. Today, thanks to substantial leaps in medical understanding, great care is taken to maintain a sterile environment and prevent infection. Yet according to the Centers for Disease Control and Prevention (CDC), two million people annually acquire some type of infection as a result of exposure to pathogens while receiving treatment or working in hospitals in the U.S. Hospital-acquired infections (HAIs) lead to 90,000 deaths and $4.5 billion in excess health care costs each year. And these estimates may be understated, since hospital reporting to the CDC is voluntary. Even in the best hospitals with the most conscientious staff, conditions may exist that promote HAIs.

Because the organism has developed substantial antimicrobial resistance, treatment of infections attibuted to A. baumannii has become increasingly difficult.

Patients often undergo invasive tests and procedures that increase their exposure. Extremely sick patients may be unable to fight off infection due to their conditions. And in some cases, improper patient handling or environmental procedures may serve to spread disease from one patient to the next.

Currently, eighteen states have laws in place concerning reporting of HAIs, with at least three more considering new legislation. While the reporting requirements vary throughout the U.S., Pennsylvania recently became the first state to publicly release hospital specific statistics on HAIs. The Pennsylvania Health Care Cost Containment Council (PHC4) surveys hospitals, establishes benchmarks, and provides its findings through public reporting. The results have been eye-opening. The mortality rate for patients with HAIs is more than five times those without infections. The average length of stay more than quadruples for patients with HAIs, and the average hospital charges for a patient with HAIs is almost six times that of non-infected patients.

Efforts must be made to curb the rate of infection, and this requires the cooperation of everyone in the health care organization. This includes ancillary departments, even when the staff has limited interaction with patients.

In the sidebar to the right are some examples, provided by the World Health Organization in its 2002 HAI prevention guide. Crothall adheres to these guidelines in the departments it manages.

This was recently demonstrated at Prince William Hospital in Manassas, VA, where Crothall performs Environmental Services. Following an incident of patient infection, unannounced tests for MRSA and VRE, two highly contagious and hard to treat diseases, were conducted on areas and equipment in the OR after Crothall performed terminal cleaning. No organisms were found. "The EVS Department is to be commended for their role in prevention and control of hospital acquired infections. They don't often get the credit they deserve," comments Bonnie Harris, CIC, Infection Control Practitioner at Prince William Hospital.

Even with the best techniques, there is some doubt as to whether HAIs can be completely eliminated. Proper management of all hospital departments, and collaboration on infection control committees, is the most effective course of action to reduce instances of infection. As more state legislatures (and potentially the federal government) begin to mandate public reporting, the issue will become even more prominent. This will allow patients to make more informed decisions about health care organizations. Only by taking a proactive approach can hospitals ease concerns.